Beyond the prison gate: why women’s health matters to rehabilitation

Menopause is rarely at the centre of Westminster’s debate about prisons. But a recent visit to HMP Bronzefield showed why it belongs in a much wider conversation about women’s health, mental health, rehabilitation and public safety.

I visited Bronzefield with Carolyn Harris MP, one of Parliament’s leading menopause campaigners, and a delegation of state legislators from California. Hosted by Sodexo, the visit offered an insight into the challenges facing women in custody and the work taking place to prepare them for release. 

Bronzefield is Europe’s largest women’s prison, with capacity for more than 500 women. Yet the average stay is just 74 days. 

Staff may therefore have little more than two months to identify health needs, begin treatment, address substance misuse, deliver education and plan for release. For women on remand or very short sentences, there may be even less time. 

Menopause in a wider health picture

The visit focused particularly on the experience of menopause in custody. 

Poor sleep, anxiety, brain fog, fatigue and changes in mood can make an already difficult environment harder to manage. These symptoms may also sit alongside trauma, neurodivergence, substance dependency and poor mental health. 

The danger is that a health need is treated solely as a behavioural problem. Difficulty concentrating can look like disengagement. Problems with memory can appear to be non-compliance. 

A menopause-aware approach is not about weakening accountability. It is about making better assessments and giving rehabilitation a greater chance of succeeding. 

The same principle applies to acquired brain injury. Research at HMP Drake Hall found that almost two in three women reported a history indicative of brain injury, mostly sustained through domestic abuse. Such injuries can affect memory, communication, concentration and impulse control, but often remain undiagnosed. 

Menopause can add another layer to this already complex picture. It should not become a catch-all explanation, but nor should it be overlooked. 

Britain’s mental health crisis does not stop at the prison gate

Around three-quarters of women in prison report mental health problems. More than eight in ten surveyed by HM Inspectorate of Prisons said they had felt unable to cope at some point in custody. The rate of self-harm in women’s prisons is more than nine times that in the male estate. 

During my time as a Shadow Health Minister, I saw repeatedly why early intervention and prevention matter. Supporting someone before a crisis takes hold is better for that individual, their family and the public purse. It also reduces pressure on hospitals, emergency services, the police, courts and prisons. 

But early intervention must not end when somebody enters the criminal justice system. Lives which have gone off track can still be brought back. 

The difficult politics of early release

The debate about the early release of prisoners has understandably caused anger and anxiety. Victims and their families must never feel like an afterthought, while public safety must remain the Government’s first responsibility. 

The debate is taking place against the reality of a prison system under severe pressure. There are no easy choices. Pretending otherwise may generate a good headline, but it does not resolve the underlying problem. 

Release, whether at the end of a full sentence or at an earlier statutory point, cannot simply mean opening the prison gate. Without stable accommodation, healthcare, employment support and properly resourced probation services, pressure is merely transferred from prisons into communities. 

Rehabilitation is not an alternative to public protection. Done properly, it is an essential part of it. 

Making rehabilitation real

The latest figures show that 66% of adults released from custodial sentences of under 12 months committed a proven reoffence. For sentences of six months or less, the figure was more than 68%. 

Short sentences can disrupt housing, employment, family relationships and treatment, while providing too little time for meaningful rehabilitation. 

Bronzefield brings that problem into sharp focus. Alongside high levels of substance misuse and mental ill health, we saw practical routes towards change through catering, horticulture, bicycle repair, creative work and salon training. Women can work towards qualifications, improve their English and maths and receive employment support. 

Sodexo’s Starting Fresh programme provides an important bridge between this work and life outside. Through training, practical support and partnerships with employers, it has created more than 300 employment opportunities for people with convictions. It demonstrates what rehabilitation can achieve when skills developed in custody lead to a genuine job on release. 

Yet progress can quickly be lost when someone leaves before completing a course or establishing contact with the right service outside. 

That challenge was also central to an important dinner I attended at the Old Bailey with Sodexo and James Timpson, the previous Prisons Minister. In a building closely associated with judgement and sentencing, the discussion focused on what comes next: employment, stability and second chances. 

Work provides more than a wage. It offers routine, responsibility and a stake in society. But prisons cannot deliver this alone. Employers, education providers, health services and community organisations must help build a bridge beyond the prison gate. 

There is no contradiction between taking crime seriously and believing people can change. A justice system must punish wrongdoing, protect the public and recognise the harm experienced by victims. But if it does nothing to reduce the likelihood of the next offence, it has left one of its most important jobs unfinished. 

Early intervention can keep lives on track. Effective rehabilitation can bring them back. 

This blog represents the views of Paula Sherriff, Senior Advisor at The Purpose Coalition.